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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ2430009
Regular
Feb 09, 2015

GIOVANNI SOSA vs. THE KROGER COMPANY, dba RALPHS GROCERY

Here's a concise summary for a lawyer: The Workers' Compensation Appeals Board granted reconsideration on petitions from both the applicant and defendant regarding a decision filed December 1, 2014. The applicant appealed findings on industrial medical conditions, the need for medical treatment, temporary and permanent disability, and attorney fees. The defendant contested the finding that obesity was aggravated by the industrial injury, the failure to apportion permanent disability to obesity, and the occupational group rating. Reconsideration is necessary to allow further study of the factual and legal issues for a just decision.

Workers' Compensation Appeals BoardReconsiderationPetitions for ReconsiderationIndustrial InjuryRight Knee InjuryInternal Systems InjuryLumbar Spine InjuryPsyche InjuryMedical TreatmentTemporary Disability
References
Case No. STK 162499, STK 162500, STK 162501
Regular
Feb 15, 2008

SHARON A. HOLLINS vs. AC TRANSIT, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration and rescinded three findings of fact and awards. This action was taken because the original decisions failed to properly address apportionment issues, specifically concerning the applicant's obesity and a prior disability award. The cases are now returned to the trial level for further proceedings and new decisions by the judge.

ApportionmentAgreed Medical EvaluatorIndustrial InjuryPermanent DisabilityObesityPrior AwardLabor Code Section 4664Petition for ReconsiderationFindings and AwardsRescinded
References
Case No. ADJ9112665
Regular
Sep 18, 2017

SHERRY MITCHELL vs. SILGAN CONTAINER CORPORATION, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address the applicant's contention that the QME's apportionment opinion regarding knee disability lacked substantial evidence. The Board found that Dr. Pattison's opinion did not sufficiently explain how obesity contributed to the applicant's knee disability. Consequently, the Board affirmed the original award but deferred issues of permanent disability and attorney's fees, remanding the case for further proceedings with the QME to provide a more reasoned apportionment opinion.

Workers' Compensation Appeals BoardSilgan Container CorporationZurich American Insurance CompanyESISSherry MitchellADJ9112665Opinion and Order Granting Petition for ReconsiderationFindings and AwardQualified Medical EvaluatorThomas S. Pattison M.D.
References
Case No. ADJ556119 (VNO 0500866), ADJ2527731 (VNO 0500867), ADJ3849638 (VNO 0500870)
Regular
Sep 10, 2013

ALVARO AGUILLA vs. FULLMER CONSTRUCTION COMPANY, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to review the applicant's permanent disability apportionment. The Board found the Agreed Medical Examiner's (AME) apportionment opinion regarding pre-existing degenerative disc disease and obesity to be inconsistent and lacking substantial medical evidence. Due to the AME's failure to provide a well-supported basis for apportionment, the Board rescinded the previous award. Consequently, the applicant was awarded 100% permanent disability without apportionment.

ApportionmentAgreed Medical Examiner (AME)Substantial Medical EvidencePermanent DisabilityWCJReconsiderationVocational RehabilitationCausationCumulative TraumaDegenerative Disc Disease
References
Case No. ADJ1957961
Regular
Feb 15, 2011

ANTHONY COX vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied applicant Anthony Cox's Petition for Removal, upholding the judge's decision to take the case off calendar. This was done to allow the defendant to depose the agreed medical examiner regarding apportionment of the applicant's permanent disability to non-industrial obesity. The Board found that clarification of the AME's opinion served both parties' interests and that removal was not warranted as applicant failed to demonstrate substantial prejudice or irreparable harm. The dissenting opinion argued that discovery should have closed per statute and that further development of the record was premature before trial.

Petition for RemovalWCJOff CalendarAgreed Medical Evaluator (AME)ApportionmentObesityPre-existing Degenerative ChangesDeclaration of Readiness to ProceedMandatory Settlement Conference (MSC)Discovery
References
Case No. ADJ7006877
Regular
Jul 22, 2014

JANET PARKER vs. COSTCO WHOLESALE, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a defendant's petition to remove an order limiting discovery subpoenas. The defendant sought medical records related to the applicant's spine, left knee, hernia, pain syndrome, arthritis, and obesity, arguing relevance to claimed injuries. The applicant agreed to include left knee records but not other potentially unrelated conditions. The Appeals Board granted the petition, amended the order to include left knee records, and allowed parties twenty days to reach an informal agreement on other records, otherwise returning the matter to the trial level.

Petition for RemovalOrder Limiting Subpoenas Duces TecumSutter Regional Medical FoundationBay Spine Medical Associatesspineleft kneeherniapain syndromearthritisobesity
References
Case No. ADJ6552578
Regular
Sep 12, 2016

ARDELL MOORE vs. FASTRIP FOOD STORE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of the decision regarding applicant Ardell Moore's permanent disability. The Board adopted the findings of the workers' compensation administrative law judge, who determined that the Panel Qualified Medical Examiner's (PQME) opinions on apportionment were not substantial medical evidence. The PQME's reports lacked sufficient reasoning and scientific basis to support conclusions regarding the apportionment of permanent disability between industrial and non-industrial causes, particularly concerning the applicant's obesity. Therefore, the Board found the PQME's apportionment opinions to be speculative and not in compliance with legal requirements for substantial evidence.

Permanent disabilityApportionmentCausationMedical opinionSubstantial evidencePanel Qualified Medical Examiner (PQME)Industrial causationNon-industrial causesPhysician's reasoningObesity
References
Case No. ADJ6526755; ADJ6526979 ADJ6671938; ADJ6672994
Regular
Jul 13, 2015

Diane Nye vs. WALGREENS COMPANY

In this workers' compensation case, the Workers' Compensation Appeals Board denied Walgreens' petition for reconsideration of four findings and awards issued to applicant Diane Nye. Walgreens challenged the awards, claiming a May 14, 2004 psychiatric injury was nonindustrial, the combined permanent disability exceeded 100%, further apportionment was needed for obesity, smoking, and a subsequent nonindustrial injury, and Nye's occupation was misclassified. The Board found substantial evidence supported the WCJ's findings, including industrial psychiatric injury and appropriate apportionment based on AME opinions. The Board also affirmed the dual occupation classification and resulting permanent disability rating, as Nye's stock clerk duties were an integral part of her employment.

Petition for ReconsiderationIndustrial InjuryPsycheHypertensionGastric SystemPermanent DisabilityAgreed Medical EvaluatorApportionmentObesitySmoking
References
Case No. ADJ11207109; ADJ11207111
Regular
May 29, 2025

Darren Hailey vs. Continental Labor, National Union Fire Insurance Company

Applicant Darren Hailey sought reconsideration of two Findings and Awards from October 19, 2021, in cases ADJ11207109 and ADJ11207111, where a WCJ found industrial injuries but apportioned 50 percent of permanent disability to nonindustrial factors based on a Qualified Medical Evaluator's (QME) opinion. Hailey contended that the QME's apportionment opinion was not substantial medical evidence. The Workers' Compensation Appeals Board, in a majority decision, affirmed the WCJ's findings, concluding that the QME adequately explained the basis of his apportionment, attributing 50 percent of the impairment to nonindustrial obesity due to its role in inhibiting recovery and causing accelerated wear and tear on joints. However, Commissioner Katherine A. Zalewski dissented, agreeing that the QME identified the factors of permanent disability but arguing that he failed to adequately explain how he arrived at the 50 percent apportionment figure, deeming the analysis incomplete.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentQualified Medical Evaluator (QME)Industrial InjuryNonindustrial FactorsCausationSubstantial Medical EvidenceObesity
References
Case No. ADJ9747467
Regular
Sep 22, 2015

DAVID ANDERSON vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION; CALIPATRIA STATE PRISON

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration of an amended award. The defendant argued that the medical opinions relied upon by the judge were not substantial evidence. However, the Board found the opinions of Dr. Shorr, the agreed panel qualified medical examiner, to be substantial evidence. Dr. Shorr opined that the applicant's obesity was aggravated by decreased activity post-injury and required treatment to relieve the work injury. The Board adopted the judge's reasoning in denying reconsideration.

Workers' Compensation Appeals BoardApplicantDefendantAmended Findings and AwardAOE/COECorrectional OfficerHeadachesSleep DisorderPermanent DisabilityFurther Medical Treatment
References
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